Epinephrine can help treat severe anaphylactic reactions in children and adults. Learn when to administer an epinephrine shot and how to do it safely.  

By Nancy Rones
Updated February 23, 2021
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If your child has severe allergic reactions (anaphylaxis), it's important to know how to give an epinephrine shot—usually from an pre-filled injectable device such as an EpiPen. Epinephrine can help treat life-threatening anaphylaxis until your child gets emergency medical treatment.

An epinephrine shot is easy to administer and can help save your child's life. It's used at the first signs of reaction to an allergen, whether it's medication, food, insect bites, latex, or something else. Once injected into the body, it works by opening the airways and narrowing the blood vessels. 

To best prepare for severe allergic reactions, you should also devise an anaphylaxis action plan with your allergist, says Hemant Sharma, M.D., director of the Food Allergy Program at Children's National Health System in Washington, D.C.  Go to foodallergy.org/faap to print out instructions that you can share with others.

EpiPen past expiration date
Credit: LUCAS TRIEB/AFP/Getty Images

How to Administer Epinephrine Shots

Your healthcare provider can show you how to administer epinephrine shots, and you should always read the instructions after filling your prescription. Training devices (without a needle or medication) can also hone your skills in giving an EpiPen dose. Practicing and discussing the shot with your child before an emergency can help them become a willing participant.

Children must hold still during the injection. If they can't, have another adult hold them—or you can lay down across their chest to keep them stationary. Use one hand to hold your kid's leg and the other hand to give the injection.

Here's how to use the EpiPen or EpiPen Jr Auto-Injector. Instructions might differ between epinephrine brands; find out more from the manufacturer's guidelines or foodallergy.org/faap

  1. Remove the EpiPen from the clear tube.
  2. With the orange injector's tip facing down, grab the EpiPen with one hand and make a fist. Do not touch the orange tip because that’s where the needle comes out. Seek medical help immediately for an accidental injection. 
  3. Remove the blue safety release (located at the top of the EpiPen) by pulling it straight up. Do not twist or bend it.
  4. Hold the injector close to your child's upper leg. Jab the shot forcefully into the middle of their outer thigh at a right angle (perpendicular to their thigh). The EpiPen can be given through clothing, and you should hear a click once the injection begins.
  5. Hold the injector in your child's thigh for three seconds; count to three slowly. 
  6. Remove the injector and put it in the storage tube that came in the pack. Keep it with you to give to the doctor later. 
  7. Massage the injection site for 10 seconds. 
  8. Call 911. A shot is not a cure or a complete treatment for an allergic reaction; it simply gives you more time to get your child to the hospital.

After you have given the shot, there might be liquid remaining in the injector. This remaining liquid is normal, and it doesn't mean that you should re-inject your child. That said, if symptoms don't improve, you might need to administer a second dose of epinephrine from a new automatic injection device. Ask your doctor how to tell if a second dose is necessary; don't give more than one additional dose without a healthcare professional.

Epinephrine Uses: When to Give an EpiPen Shot

Make sure your child always has immediate access to their EpiPen shot pack. Teachers and caregivers must always carry the pack and be confident giving this shot. Use an epinephrine pen in the following situations: 

Your child has one severe symptom, including breathing problems, tightness in the throat, feeling faint or having a weak pulse, swelling of the tongue or lips, hives over the whole body, or severe diarrhea or vomiting.

Your child has moderate symptoms affecting two parts of the body, including hives, itchy mouth, nausea, and sneezing or drippy nose. Note that you should hold off using the EpiPen if your child has only one mild to moderate symptom. Instead, give them a kids' antihistamine, call your doctor, and then watch for any changes.

If a child is having an anaphylactic reaction and you don't have an EpiPen, call 911. Lay them flat, with legs elevated to keep blood flowing to vital organs, advises Dr. Sharma. Prop up the child's head if they're having trouble breathing. If they're vomiting, turn them on their side until help arrives.

Epinephrine Side Effects

Epinephrine shots are a life-saving treatment for severe allergic reactions, but your child may experience some side effects after an injection. These include:

  • Redness, warmth, swelling, or tenderness at the injection site
  • Breathing difficulties
  • Irregular or fast heart rate
  • Dizziness
  • Sweating
  • Headache 
  • Nausea or vomiting
  • Anxiety or restlessness
  • Pale skin
  • Weakness
  • Uncontrollable shaking 

These symptoms usually go away shortly, but tell your doctor about any lingering or bothersome epinephrine side effects.

When to Replace Epinephrine Shots

Epinephrine shots are only effective if the medicine is still potent. They don't need to be refrigerated, but they should be kept at room temperature and away from direct sunlight. There are three instances when the shot pack should be replaced: the liquid in the injector is no longer clear, particles are floating in it, or the expiration date on the shot pack has passed. In these cases, get your prescription refilled immediately to replace the shot pack. Also, it's important to discard epinephrine shots after one use.